Department of Research and Development, Puntland University of Science and Technology , Galkayo City, Somalia.
Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University , Umeå, Sweden.
Glob Health Action. 2020 Dec 31;13(1):1803543. doi: 10.1080/16549716.2020.1803543.
As in many Sub-Saharan African countries, the health system in Somalia is not operating at the capacity needed to lift childhood vaccination coverage to ninety percent or above, as recommended by United Nations Children's Fund. Current national estimates of coverage for the six major vaccine preventable childhood diseases range from thirty to sixty percent. Infectious disease outbreaks continue to pose significant challenges for the country's health authorities.
This important qualitative study, conducted in Galkayo District, Somalia, investigates limiting factors associated with childhood vaccination uptake from the perspective of both communities and health care workers.
Qualitative information was collected through six focus group discussions with parents (n = 48) and five one-to-one interviews with health workers (n = 15) between March and May 2017, in three settings in the Galkayo District - Galkayo city, Bayra and Bacadwayn.
From a health system perspective, the factors are: awareness raising, hard to reach areas, negative attitudes and perceived knowledge of health workers, inadequate supplies and infrastructure, and missed vaccination opportunities. From the perspective of individuals and communities the factors are: low trust in vaccines, misinterpretation of religious beliefs, vaccine refusals, Somalia's patriarchal system and rumours and misinformation. Parents mostly received immunization information from social mobilizers and health facilities. Fathers, who are typically family decision-makers, were poorly informed. The findings highlight the need for in-service training to enable health workers to improve communication with parents, particularly fathers, peripheral communities and local religious leaders.
Enhancing knowledge and awareness of vaccination among parents is crucial. Fathers' involvement is lacking. This may be boosted by highlighting fathers' obligation to protect their children's health through vaccination. It is also important that men engage with the wider community in decision-making and advance towards the global vaccination targets.
与许多撒哈拉以南非洲国家一样，索马里的卫生系统无法达到联合国儿童基金会建议的将儿童疫苗接种覆盖率提高到 90%或以上的水平。目前，该国六种主要疫苗可预防儿童疾病的覆盖率在 30%至 60%之间。传染病的爆发仍然对该国卫生当局构成重大挑战。
这项重要的定性研究在索马里的加勒卡约区进行，从社区和卫生保健工作者的角度调查了与儿童疫苗接种率相关的限制因素。
2017 年 3 月至 5 月期间，在加勒卡约区的加勒卡约市、拜拉和巴卡德温三个地区，通过六组父母（n=48）的焦点小组讨论和与 15 名卫生工作者（n=15）的五对一访谈收集定性信息。
从卫生系统的角度来看，这些因素包括：提高认识、难以覆盖的地区、卫生工作者的负面态度和认知、供应和基础设施不足以及错过接种机会。从个人和社区的角度来看，这些因素包括：对疫苗的低信任度、对宗教信仰的误解、疫苗拒绝、索马里的父权制以及谣言和错误信息。父母主要从社会动员者和卫生机构获得免疫信息。作为家庭决策者的父亲则信息匮乏。研究结果强调了在职培训的必要性，以使卫生工作者能够改善与父母、特别是父亲、周边社区和当地宗教领袖的沟通。
提高父母对疫苗接种的知识和认识至关重要。父亲的参与度不足。通过强调父亲有义务通过疫苗接种来保护孩子的健康，可以提高他们的参与度。同样重要的是，男性要参与更广泛的社区决策，并朝着全球疫苗接种目标迈进。
